A major goal of modern radical prostatectomy is the preservation of the unmyelinated autonomic fibers serving the corpus cavernosum, because injury to these fibers is associated with post-operative erectile dysfunction. Thermal injury is well known to cause problems with erectile dysfunction, as is mechanical injury due to excision, traction, or blunt injury. As such, the avoidance of electrocautery as a source of thermal injury during surgery is one method of achieving the objectives of Anatomical prostatectomy.
Several methods of non-cautery prostatectomy have been proposed including the extensive use of ligatures, surgical clips, vascular bulldogs, bioadhesives and sealants, and the employment of bipolar as opposed to monopolar cautery for hemostasis. However, such methods seem directed at controlling the major vascular structures such as the Dorsal Venous Complex and Lateral Vascular Pedicles of the prostate while significant intra operative and post-operative bleeding may occur due to bleeding at the arteriolar and capillary level such as on the bladder neck and periprostatic tissues, and pre rectal plane containing and including the neurovascular bundles. It has observed by many that surgeons generally fall back upon cautery when bleeding occurs at these sites (William Catalona, American Urological Association Meeting Prostate Cancer Review Course, San Francisco, 2010). Therefore, no method of non-cautery prostatectomy has gained wide acceptance or emerged giving reliable results in terms of sexual or urinary function.
Accordingly, research continues in an effort to discover methodologies for performing a radical prostatectomy that is nerve sparing without the need for electro-cautery, in general, and monopolar electro-cautery, in particular.